Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5–7 years after laparoscopic ventral hernia repair

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 14; no. 5; pp. 499 - 504
• Main Authors: Zinther, N. B., Wara, P., Friis-Andersen, H.
• Format: Journal Article
• Language: English
• Published: Paris Springer-Verlag 01.10.2010; Springer Nature B.V
• Subjects: Abdomen - diagnostic imaging; Abdomen - pathology; Abdominal Surgery; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Follow-Up Studies; Hernia, Ventral - surgery; Humans; Laparoscopy - methods; Magnetic Resonance Imaging, Cine - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Polytetrafluoroethylene - adverse effects; Retrospective Studies; Surgical Mesh - adverse effects; Tissue Adhesions - diagnosis; Tissue Adhesions - etiology; Ultrasonography; Visceral slide; Magnetic resonance imaging; Laparoscopic ventral hernia repair; Intra-abdominal adhesions; Transabdominal ultrasonography; IPM
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-010-0676-x

Background Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5–7 years after LVHR, using two validated non-invasive radiologic methods. Methods Real-time transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (MRI) was applied to 30 patients with prior LVHR and implantation of IPM (Intramesh W3, Cousin Biotech, France). The visceral slide was measured in nine predefined abdominal segments. Values ≤1 cm were defined as an area with adhesion. Results The mean time between LVHR and TAU/cine MRI was 67 months (range, 58–80 months). We found adhesion to the mesh in 90% of the patients using TAU and 100% of the patients using cine MRI. In the latter, 65% were between the bowel and IPM. Conclusions LVHR is known to reduce recurrences and postoperative complications, while improving patient outcome. The intraperitoneal placement of the mesh has been shown to induce adhesions; the amount and extension in the clinical setting is unclear. The present study showed a marked proportion of adhesions to the mesh with an average surgery to scan time of 5.6 years, despite an anti-adhesive barrier on the visceral surface of the mesh. Together with existing data, this result increases the concern related to the long-term consequences of an IPM. As a consequence, a comprehensive and comparable test system for medical devices, i.e. IPM, is needed.